Isoseparation curves: a mechanism for optimizing off-axis dose homogeneity of intact breast irradiation

The purpose of this paper is to determine whether using off-axis isoseparation curves to optimize the collimator rotation angle improves dose homogeneity. Eleven intact breast irradiation patients underwent computerized tomography (CT) treatment planning with 1 cm abutting slices. Central plane treatment planning, using 6 MV photons, tissue inhomogeneity corrections, and isocentric opposed tangent treatment fields, was performed. Collimators were rotated to match chest wall slope through the use of a beam's-eye-view setting. Patient separations were measured from the apex of the breast to the posterior field border on each axial CT slice. Sagittal-plane isoseparation curves were constructed from these measurements. Using these curves, the collimator rotation that minimized off-axis separation differences was determined. A comparison of off-axis dose inhomogeneity was performed for patients with a > or =10 degrees difference between this optimized collimator angle and the angle determined by chest wall slope. These comparative treatment plans differed only with respect to collimator angle rotation. The mean optimal collimator rotation angle differed significantly from the mean rotation angle which matched the chest wall slope (5.4 degrees vs. 11 degrees, respectively, P < 0.001). Four of the 11 patients had rotation angle differences of 10 degrees. In these patients, the optimization of collimator angle reduced the percentage of breast volume to "that" received > or =110% of the prescribed dose. For the patient with the largest breast size to the patient with the smallest breast size the decreases were, respectively, 5% (15% to 10%), 3% (24% to 21%), 1% (4% to 3%), and 1% (0.9% to 0%). The mean reduction in dose inhomogeneity was greatest in the inferior breast quadrants. At 6 cm and 4 cm off axis, the mean reductions in the percentages of the breast tissue to "that" received 110% of the prescribed dose were respectively 15.1% and 5.3 %. Optimizing the collimator angle through the use of isoseparation curves decreases dose inhomogeneity. The greatest improvements are in the inferior quadrants of the intact breast. The improved dose homogeneity may have clinical relevance in the treatment of patients with large breast sizes.     

National quality of care activities in Germany

The burn nursing Delphi study identified pain management as the most important area of burn nursing research. The question, "What is the best method to measure the pain of the patient with burns?" ranked in the top 10% of the nursing research priorities and is the research question of this study. The most commonly used pain assessment tools were determined in a 1994 survey of burn centers. Of those that responded, 67% used the Visual Analog Scale and 43% used an adjective scale. Forty patients were enrolled in this prospective, multicenter study. Visual analog and color scales were used during a 3-day cycle and word and faces scales were used during another 3-day cycle. Pain levels were assessed twice each day, once during a quiet time and then again immediately after a painful activity. At the end of each 3-day cycle the patient was asked which tool he or she preferred. At the completion of the study period the patient was asked to select the overall most preferred tool for pain assessment. Although this study indicates that patients prefer the faces and color scales to the most commonly used visual analog and adjective scales, further research is needed to determine the potential impact of preferred tools on pain intervention. The results may also lead burn centers to re-evaluate current selection of pain assessment tools.     

Nutrition support for patients after cardiopulmonary bypass: required modifications of the TPN solution

Background electrolyte (BGE) systems with two coions are frequently used in capillary zone electrophoresis (CZE), especially in cases where indirect optical detection is employed. This study investigates the behavior of analytes, which possess mobilities intermediate to those of the BGE coions used. Besides the expected behavior, where the analytes provide either tailing or fronting zones, unusual behavior with extraordinary zone broadening is also observed in some cases. The explanation for this effect is that binary BGE systems involve, as a physico-chemical rule, a region where the analytes are forced by one coion to give tailing zones and simultaneously by the other coion to give fronting zones. The result of this "schizophrenic" situation is extraordinary zone broadening and deterioration of the detection record. A series of experiments is presented showing in a telling way the electromigration behavior of the discussed type of zones as well as the ways to remedy the deterioration of the peak shape by a mere slight changing of the quantitative composition of the BGE used.     

Light scattering from an optically active sphere into a circular aperture

To show how apertures affect measurements of the circularly polarized components of light scattered to a detector, we develop two methods of averaging the V and I Stokes parameters over a circular aperture that collects light scattered from an optically active sphere. One method uses a two-dimensional numerical integration that is appropriate for small apertures, and the other gives analytical expressions for scattering into a solid angle of any size. We identify the aperture locations that, independent of aperture size, give an average V (and an effective degree of circular polarization) of zero for scattering from an optically inactive sphere and of nonzero for scattering from an optically active sphere.     

The role of topology in engineering design research

Aspects of the mathematical specialty of topology appear within several seemingly distinct areas of engineering design and engineering design theory. Indeed, the expression topology of a design is often used informally. In this article a primary intent is to demonstrate the diversity of applications of topology within engineering design. A complementary goal is to introduce the engineering design community to topology as a rich, formal, well-established mathematical discipline that may be of value for wider study. Upon reviewing some of these topological applications, it appears that topology holds promise as a basis for formalizing engineering design theory. This article considers topology as a basis for unifying design abstractions. The potential benefit may be the realization of commonalities between design aspects previously considered separately, where each now has its own attendant specialized, expensive analyses.     

Structural and residual stress changes in Mo/a-Si multilayer thin films with annealing

The thermal and mechanical stability of molybdenum and amorphous silicon (Mo/a-Si) optical multilayers (3 and 4 nm nominal thickness of Mo and Si) at 316 °C were studied by annealing experiments. Growth of amorphous Mo-Si interlayers with a stoichiometry of 12 was observed at the Mo/a-Si interfaces. In addition, residual stresses significantly changed in the crystalline Mo and amorphous Si layers with annealing. High resolution electron microscopy, selected area electron diffraction, and X-ray diffraction of the crystalline Mo revealed that tensile stresses increased from 2 to about 10 GPa in the lateral direction (parallel to the interface plane). The compressive strains that developed in the vertical direction (perpendicular to the interface plane) are consistent with Poisson's ratio. Laser deflectometer measurements of thicker (0.1 m) amorphous silicon layers may indicate compressive-stress relaxation in the amorphous silicon with annealing, consistent with other investigations. Overall, the residual stress in a 40-bilayer film changes from about –0.5 to about +1.5 GPa. Structural transformation after relatively short annealing times at the interfaces in the thin amorphous Mo-Si interlayers may rationalize increased tensile strains in the Mo layers.     

A test of the fail-safe N for self-help programs.

A meta-analysis of published studies on the clinical efficacy of selected self-help programs (F. Scogin et al; see record 1990-15222-001) indicated that such conditions were more effective than no-treatment controls. Calculation of a fail-safe N showed that 53 nonsignificant studies would have to exist to render the conclusions of the meta-analysis invalid. Results indicate that unpublished research is unlikely to threaten the validity of the original meta-analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

同行导师体验报告(英文)

Students at the University of Derby are required to complete a year in industry as part of their Bachelor of Science degrees.This is a daunting prospect for some of them,and they can be reluctant to engage in the process of finding a placement position.As part of a second year module,students seeking placement are paired with students already on placement in a mentee/mentor relationship to support the second year students in their search for an internship.This arrangement helps the mentees by introducing them to potential role models close to their experience,receiving encouragement from peers and the inculcation of belief that it is possible to find a placement.The mentors also benefit from a recognition of how much they have learnt.However,there are difficulties in establishing and managing the scheme which should be recognised.This paper reports our experience over the last three years.     

On the efficiency of bootstrap method into the analysis contingency table

The bootstrap method is a computer intensive statistical method that is widely used in performing nonparametric inference. Categorical data analysis, in particular the analysis of contingency tables, is commonly used in applied field. This work considers nonparametric bootstrap tests for the analysis of contingency tables. There are only a few research papers which exploit this field. The p-values of tests in contingency tables are discrete and should be uniformly distributed under the null hypothesis. The results of this article show that corresponding bootstrap versions work better than the standard tests. Properties of the proposed tests are illustrated and discussed using Monte Carlo simulations. This article concludes with an analytical example that examines the performance of the proposed tests and the confidence interval of the association coefficient.     

On Delivery Times in Packet Networks under Adversarial Traffic

We consider packet networks and make use of the "adversarial queuing theory" model [10]. We are interested in the question of guaranteeing that all packets are actually delivered to destination, and of having an upper bound on the delivery times of all packets. Whether this is possible against all adversarial queuing theory rate-1 adversaries was previously posed as an open question [13],[10]. Among other things, we give a queuing policy that guarantees bounded delivery time whenever the rate-1 adversary injects a sequence of packets for which there exists a schedule with a finite upper bound on the delivery times of all packets, and adheres to certain additional conditions. On the negative side we show that there exist rate-1 sequences of packets for which there is no schedule with a finite upper bound on the delivery times of all packets. We thus answer an open question posed by Gamarnik [13]. We further show that delivering all packets while maintaining stability (we coin the term "reliability" for this property) can be done by an offline scheduler whenever the injection of packets is done at rate of at most 1. However, on the other hand, we also show that there is no online protocol (even centralized) that can achieve that property against all rate-1 adversaries. We thus answer an open question of Borodin et al. [10].